Rheumatic heart valve disease is a heart disease that is left over from acute rheumatic heart disease and is dominated by valvular lesions. After repeated inflammation of the original smooth, thin, soft and elastic valve, the valve thickens, adheres, deforms and shortens and thickens the tendons, resulting in valve stenosis or incomplete closure. The disease is more common in young people, more women than men, and about 2/3 of the patients have suffered from typical rheumatic diseases when the medical history is followed.
I. Etiology and onset
Patients usually suffer from rheumatism first. It is currently believed that rheumatism is a chronic and recurrent metabolic disease, which is related to the infection of Streptococcus haemolyticus type A. The lesion involves the heart and is called rheumatic cardiitis, which often leaves permanent damage to the heart valves and is progressively aggravated by the frequent recurrence of rheumatic disease, producing hemodynamic changes and leading to heart failure, endangering life and health.
Second, patient performance
Due to the degree and location of valve damage, patient performance varies, the most common site of damage is the mitral valve, followed by the aortic valve, as follows.
1.Micuspid stenosis
When mitral stenosis occurs, the blood in the left atrium flows poorly into the left ventricle, increasing the blood and pressure in the left main atrium, causing hypertrophy and expansion of the left atrium, and the pressure in the pulmonary veins and pulmonary capillaries also increases at any time, resulting in expansion and stasis, forming chronic pulmonary obstructive congestion, and when physically active, the patient has respiratory distress, and in severe cases, seated breathing or nocturnal paroxysmal dyspnea, aggravated by coughing, often accompanied by hemoptysis. Cyanosis and pulmonary edema (large amounts of pink frothy sputum), by which time the patient has become in left atrial failure. The progression of the disease leads to pulmonary hypertension, hypertrophy and enlargement of the right ventricle due to increased burden, and finally right heart failure, which causes venous depression, liver enlargement and distension, subcutaneous edema and ascites.
Diastolic murmurs can be heard on auscultation, and enlarged left atrium and right ventricle can be detected on X-ray. The electrocardiogram may reveal abnormalities such as hypertrophy of the left atrium and right ventricle.
2.Micuspid valve insufficiency
In mitral valve insufficiency, the blood volume of the left atrium increases due to blood regurgitation, and the left atrium is enlarged and hypertrophied. The excess blood from the left atrium flows back to the left ventricle during ventricular diastole, causing enlargement and hypertrophy of the left ventricle, and gradually loses compensatory function, followed by pulmonary stasis and increased pulmonary artery pressure, causing hypertrophy and expansion of the right ventricle. If the heart is well compensated, the patient may have no obvious symptoms. If the compensatory capacity is lost, the patient may have weakness, palpitations, dyspnea after exertion and other manifestations of left heart failure. Finally, right heart failure manifestations such as edema and abdominal distension may appear.
There may be obvious systolic murmur on cardiac auscultation, and the left atrium and left ventricle may be enlarged on X-ray. There may be abnormal findings in electrocardiogram.
3.Aortic valve insufficiency
Aortic valve insufficiency causes increased blood volume in the left ventricle, resulting in compensatory dilation and hypertrophy. Those with mild lesions or strong compensatory capacity may be asymptomatic for a long time. Those with significant lesions may have palpitations, shortness of breath, precordial discomfort and head pounding sensation, a few have angina pectoris, and in severe cases, symptoms of left heart failure.
The patient’s blood pressure can be measured with increased systolic pressure and decreased diastolic pressure, and capillary pulsations can be seen in the lips and nails (the pulsations are more obvious under the nail bed when the nails are lightly pressed). x-ray examination can reveal an enlarged heart to the left and a boot-shaped heart, also known as an aortic valve heart. The electrocardiogram is normal or abnormal.
4.Aortic valve stenosis
In aortic stenosis, compensatory hypertrophy and dilatation occurs due to obstruction of left ventricular blood drainage. Severe stenosis can cause reduced coronary blood flow and insufficient cerebral blood supply. In mild cases, there may be no obvious symptoms, while in severe cases, vertigo or syncope may occur due to cerebral ischemia, or angina pectoris may result from insufficient coronary blood supply and myocardial hypertrophy, or even sudden death. Late stage may have symptoms of left heart failure.
There may be a systolic murmur in the aortic valve area on auscultation, and left ventricular hypertrophy and enlargement on X-ray. Abnormal changes can be seen in electrocardiogram.
5, joint valve disease
A patient who has two or more valve lesions at the same time is called combined valve disease. The patient’s performance is basically a combination of each valve lesion.
Third, home care
1, rheumatic heart valve disease has been diagnosed, should be hospitalized. If there is no rheumatic activity, heart failure and subacute heart failure and subacute bacterial endocarditis and other co-morbidities, home care can also be carried out under the guidance of physicians.
2.Nutrition and diet
Give high-calorie easy-to-digest diet, such as fish, meat, eggs, milk, etc., small and frequent meals, and give more vegetables and fruits. Give low-salt diet to those with cardiac insufficiency, and limit water intake.
3.Home care
(1) Rest. This includes both physical strength and energy. The patient can do some light work when the symptoms are not obvious, but do not participate in heavy physical labor, so as not to increase the burden on the heart. Patients with cardiac insufficiency or rheumatic activities should be absolutely bed rest, all life should be assisted by family members. Be kind to the patient and avoid adverse stimulation.
(2) Prevent respiratory tract infection. The room should have sufficient sunlight, fresh air and suitable temperature to prevent rheumatic activities caused by respiratory tract infection and aggravation of the disease.
(3) Pay attention to the patient’s body temperature, if the patient is feverish, it means there is infection or rheumatic activity. Rheumatic activity when the pulse rate increases disproportionately with the increase in body temperature (in general, for every 1°C increase in body temperature, the pulse rate increases by about 10 times / min), that is, the pulse rate increases more. Prompt examination and treatment should be performed.
(4) If the patient has dyspnea or paroxysmal dyspnea occurs at night, which is an early manifestation of left heart failure, the patient should be put in a semi-recumbent position or with both legs down to reduce the amount of return blood to reduce pulmonary edema. If there is edema suggesting right heart failure, fluid intake and output should be recorded, weight should be observed, and attention should be paid to skin care and regular turning to prevent bedsores.
(5) Pay attention to the regularity of pulse rhythm, the rapidity of pulse rate and the strength of pulse, and report abnormalities to the physician in a timely manner.
IV. Precautions
1, taking anti-rheumatic drugs can cause the patient nausea, vomiting, stomach pain and other gastrointestinal reactions, should be given between meals or at the same time to the stomach Shu Ping 3 tablets to take.
2, taking digitalis-type cardiac drugs, should be used under the guidance of a physician, if anorexia occurs during the drug, should immediately stop the drug, and report to the physician. Once digitalis toxicity is determined, 10 ml of 10% potassium chloride solution should be taken 3 times a day. If there are frequent premature ventricular contractions, use phenytoin sodium 0.1 gram, 3 times a day intramuscularly or orally.
3. During treatment and recovery, if heart failure, severe arrhythmia, subacute bacterial endocarditis (unexplained fever, progressive anemia, hematuria, splenomegaly and bleeding spots on the skin, the occurrence of this disease should be noted), arterial embolism (dislodged atrial thrombus, blocking the cerebral artery can cause hemiplegia; blocking the pulmonary artery can cause chest pain, dyspnea and hemoptysis; blocking the renal artery can cause hematuria, etc.) should be sent to hospital in time Treatment.
V. General knowledge of prevention
This disease is a consequence of rheumatism, and active prevention of hemolytic streptococcal infection is the key to prevent this disease. Strengthening physical exercise to enhance the body’s ability to resist disease also has an important preventive role. Active and effective treatment of streptococcal infections, such as eradication of tonsillitis, dental caries and paranasal sinusitis and other chronic lesions, can prevent and reduce the occurrence of this disease.